By. RADIATION & PREGNANCY Diagnostic & Therapeutic procedures causing exposure of the abdomen of...
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Transcript of By. RADIATION & PREGNANCY Diagnostic & Therapeutic procedures causing exposure of the abdomen of...
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RADIATION & PREGNANCY
RADIATION & PREGNANCY
Diagnostic & Therapeutic procedures causing exposure of the abdomen of women likely to be pregnant should be avoided unless there is a strong clinical indications
STOCHASTIC STOCHASTIC
EFFECTSEFFECTS
STOCHASTIC EFFECTSSTOCHASTIC EFFECTS
Stochastic Effects are caused by mutations in a cell or in small group of cells
STOCHASTIC EFFECTSSTOCHASTIC EFFECTS
The absorbed dose is not important for severity of the effect, but for probability of the effect depend on the absorbed dose
STOCHASTIC EFFECTSSTOCHASTIC EFFECTS
Examples of stochastic effect
malignancies and hereditary effects.
No threshold dose.
DETERMINISTIC EFFECTSDETERMINISTIC EFFECTS
DETERMINISTIC EFFECTSDETERMINISTIC EFFECTS
Result from killing of cells.
There is a threshold dose.
e.g.: Fetal death, gross malformation
DETERMINISTIC EFFECTSDETERMINISTIC EFFECTSPre-Implantation: 0 – 8 days post-Pre-Implantation: 0 – 8 days post-conceptionconception
Death of embryo 5 cGy rats
0.9 cGy mice
Threshold dose: 10 cGy
DETERMINISTIC EFFECTSDETERMINISTIC EFFECTS
Embryonic = 9 – 60 daysEmbryonic = 9 – 60 days
Risk of embryonic death remain.higher threshold dose.Risk of malformation is in the order of 0.5% per cGyThreshold dose = 10 cGy
Small head size 1% per cGyThreshold dose = 10 – 20 cGyGrowth retardation threshold dose = 5 – 25 cGy
DETERMINISTIC EFFECTSDETERMINISTIC EFFECTS
Early fetal = 61 – 104 daysEarly fetal = 61 – 104 days
Threshold dose for lethality = 0.5 Gy
Mental retardation 0.4% per cGyThreshold dose = 12 cGy
0.3 IQ points per cGyUnprovoked seizures 4 – 8 cGy threshold doseAll seizure 11 – 15 cGy threshold dose
DETERMINISTIC EFFECTSDETERMINISTIC EFFECTS
Mid fetal = 105 – 175 days post-conceptionMid fetal = 105 – 175 days post-conception
Risk of fetal death remain in this period, but seems to be lower than in the earlier period
Threshold doses
0.65Gy for mental retardation
0.5 Gy for small head size
0.5 Gy for growth retardation
DETERMINISTIC & EFFECTSDETERMINISTIC & EFFECTS
Late fetal = more than 175 days post-conceptionLate fetal = more than 175 days post-conception
Risk of fetal death seem to be low
Risk of malformation & mental retardation are negligible
STOCHASTIC EFFECTS
STOCHASTIC EFFECTSSTOCHASTIC EFFECTS
Excess Fatal CancerExcess Fatal Cancer
Natural prevalence of fatal childhood cancer up to the age of 15-year (1:1300)
0.03% per cGy0.04% - 0.05% cGyHigher risk for those irradiated in the second trimester than those in third trimester
TUMOURSTUMOURS
TUMOURSTUMOURS
Leukemia, tumours of CNS
RISK OF RISK OF GENETIC GENETIC DISEASEDISEASE
NATURAL NATURAL PREVALENCE IS PREVALENCE IS
1.6%1.6%
Maternal age > 35Total chromosal abnormality is 2.26% & 9.6% age above 45
1 cGy 0.012%
It is clear that risk of radiation effects is smaller than risk effect by age
Normal risk that a child will have congenital defect is 3% – 6%
When dose exceed 10 cGy probability increase to 10%
A dose of 10 cGy – 20 cGy is radiologically not accepted as an indication for an abortion
Dose to the embryo of 20 cGy at 3-Weeks could be accepted as a reason for “Therapeutic Abortion”
Whalen & Batter
Dose from Nuclear Medicine Diagnostic test is at’s highest estimate 1 cGy
Threshold dose for deterministic effect is in the order of 10 cGy – 60 cGy
The risk of cancer induction is 0.03% - 0.06% per cGy
If patient received 0.5 cGy
(1.5 – 2.5) out of 10,000
Risk of genetic defect
(0.5 – 5) out of 10,000
ProjectionProjection ExaminationExamination
Estimated Fetal Dose per Examination (mGy)Estimated Fetal Dose per Examination (mGy)
Mean Mean
(this work)(this work)Reported Reported
MeanMeanRange Range
(this work)(this work)Reported RangeReported Range
AP Abdomena 2.9 1.9 0.26 – 15.0 0.16 – 9.2
PA Abdomena 1.3 0.53 0.64 – 3.0 0.35 – 0.82
Abdomenb 2.6 2.5 [1.4] 0.26 – 15.0 0.25 – 19.0 {4.2}
AP Chesta < 0.01 < 0.01 < 0.01 < 0.01
PA Chesta < 0.01 < 0.01 < 0.01 < 0.01
Chestb < 0.01 0.01 [< 0.01] 0.002 – 0.43 < 0.01
AP Lumbar Spinea 7.5 1.9 0.31 – 40.0 0.20 – 15.0
LAT Lumbar Spinea 0.91 0.41 0.09 – 3.5 0.09 – 3.1
Lumbar Spineb 4.2 4.0 [1.7] 0.09 – 40.0 0.27 – 40.0 {10.0}
LAT Lumbosacral Jointa 1.1 0.56 0.10 – 2.03 0.09 – 2.4
AP Pelvisb 3.4 2.0 [1.1] 1.4 – 15.0 0.55 – 22.0 {4.0}
AP Thoracic Spinea < 0.01 < 0.01 < 0.01 < 0.01 – 0.03
PA Thoracic Spinea < 0.01 < 0.01 < 0.01 < 0.01 – 0.01
Thoracic Spineb < 0.01 < 0.1 [< 0.01] < 0.01 < 0.1-0.55 {<0.01}
COMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSECOMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSE
a – Reported mean & range are adapted from Shrimpton et alb – Reported mean & range are adapted from Wagner et al
Mean values in square brackets & values curly brackets (representing only maximum values) are adapted from Sharp et al
ProjectionProjection ExaminationExamination
Estimated Fetal Dose per Examination (mGy)Estimated Fetal Dose per Examination (mGy)
Mean Mean
(this work)(this work)Reported Reported
MeanMeanRange Range
(this work)(this work)Reported RangeReported Range
IVU 4.8 6.0 [1.7] 2.9 – 6.8 0.7 – 55.0 {10.0}
Barium Enema 6.1 10.0 [6.8] 0.3 – 10.4 0.28 – 130.0 {24.0}
Barium Meal 1.5 - [1.1] 0.1 – 2.3 - {5.8}
Cholecystography 0.6 1.0 0.08 – 1.1 0.05 – 16.0
AP Urinary Bladder 3.9 0.56 – 11.0
COMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSECOMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSE
a – Reported mean & range are adapted from Shrimpton et alb – Reported mean & range are adapted from Wagner et al
Mean values in square brackets & values curly brackets (representing only maximum values) are adapted from Sharp et al
ProjectionProjection ExaminationExaminationFetal dose per examination (mGy)Fetal dose per examination (mGy)
RangeRange MeanMean
AP Abdomen 0.26 – 15.0 2.9
PA Abdomen 0.64 – 3.0 1.3
Abdomena 0.26 – 15.0 2.6
AP Chest < 0.01 – 0.01 < 0.01
PA Chest < 0.01 < 0.01
Chestb > 0.01 – 0.01 < 0.01
a – Average for the various projectionsb – For only one examination
MEAN FETAL ABSORBED DOSE PER EXAMINATION (GXR)MEAN FETAL ABSORBED DOSE PER EXAMINATION (GXR)
Contd…
ProjectionProjection ExaminationExaminationFetal dose per examination (mGy)Fetal dose per examination (mGy)
RangeRange MeanMean
AP Hip joint 0.11 – 2.1 0.9
AP Lumbar Spine 0.31 – 40.0 7.5
LAT Lumbar Spine 0.09 – 3.5 0.91
OBL Lumbar Spine 0.61 – 2.0 1.3
Lumbar Spinea 0.09 – 40.0 4.2
LAT Lumbosacral Joint 0.10 – 2.0 1.1
AP Pelvis 1.4 – 15.0 3.4
AP Thoracic Spine < 0.01 < 0.01
LAT Thoracic Spine < 0.01b
Thoracic Spineb < 0.01 < 0.01
a – Average for the various projectionsb – For only one examination
MEAN FETAL ABSORBED DOSE PER EXAMINATION (GXR)MEAN FETAL ABSORBED DOSE PER EXAMINATION (GXR)
ExaminationExamination No. of CasesNo. of CasesFetal dose per examination (mGy)Fetal dose per examination (mGy)
RangeRange MeanMean
Liver 4 2.0 – 4.4 3.6
Lumbar Spine 1 2.8
Lung 2 1.0 – 1.4 1.2
Pelvis 2 65.0 – 114.0 89.0
MEAN FETAL ABSORBED DOSE PER EXAMINATION (CT)MEAN FETAL ABSORBED DOSE PER EXAMINATION (CT)
COMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSECOMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSE
RadiopharmaceuticalRadiopharmaceuticalConversion factorConversion factor
(cGy/MBq) [1,3](cGy/MBq) [1,3]Activity (MBq]Activity (MBq] Route of Route of
AdministrationAdministrationDose to the Uterus Dose to the Uterus
(cGy)(cGy)
123I-Sodiumiodide 1.4x10-3 20 i.v. 2.8x10-2
123I-MIBG 1.1x10-3 30 i.v. 3.3x10-2
131I-MIBG 8.0x10-3 300 i.v. 2.4
67Ga-citrate 7.9X10-3 150 i.v. 1.18
201Tl-chloride 5.0x10-3 100-150 i.v. 5-7x10-1
99mTc-tetrofosmin
(1-day protocol, rest)8.4x10-4 150 i.v. 1.3x10-1
99mTc-tetrofosmin
(1-day protocol, effort)7.3x10-4 450 i.v. 3.3x10-1
MIBG, Metaiodobenzylguanidine; MDP, methylene diphosphonate; HDP, hydroxydiphosphonate; MAA, macroaggregated albumin; MAG3, mercaptoacetyltriglycine
COMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSECOMPARISON OF THE ESTIMATED MEAN & RANGE OF FETAL DOSE
RadiopharmaceuticalRadiopharmaceuticalConversion factorConversion factor
(cGy/MBq) [1,3](cGy/MBq) [1,3]Activity (MBq]Activity (MBq] Route of Route of
AdministrationAdministrationDose to the Uterus Dose to the Uterus
(cGy)(cGy)
99mTc-sestamibi
(1-day protocol, rest)7.8x10-4 150 i.v. 1.2x10-1
99mTc-sestamibi
(1-day protocol, effort)7.2x10-4 450 i.v. 3.2x10-1
99mTc-MDP 6.1x10-4 400 i.v. 2.4x10-1
99mTc-HDP 6.1x10-4 400 i.v. 2.4x10-1
99mTc-MAA 2.4x10-4 100 i.v. 2.4x10-2
81mKr-gas 6.0x10-8
(per minute)
Generator:
450-750 MBq/minuteInhalation < 10-3
99mTc-MAG3 1.2x10-3 40 i.v. 4.8x10-2
MIBG, Metaiodobenzylguanidine; MDP, methylene diphosphonate; HDP, hydroxydiphosphonate; MAA, macroaggregated albumin; MAG3, mercaptoacetyltriglycine
131131I-Therapy I-Therapy &&
PregnancyPregnancy
131131I-Therapy & PregnancyI-Therapy & Pregnancy
10 – 12 Weeks thyroid gland of fetus start to function.
For every 10mCi the mother receive, the fetus will receive
1 cGy.
.
Radiation Worker’s & PregnancyRadiation Worker’s & Pregnancy
Radiation worker who is pregnant should not
receive more than 1 mSv during the whole
pregnancy.
CONCLUSIONCONCLUSION
CONCLUSIONCONCLUSION
For diagnostic examination whether radiological or Nuclear Medicine, the risks for the fetus are
Extremely low
For therapeutic dose•The doses may be high enough to cause unacceptable tissue damage.